Approved Sleeve to RNY

Thanks.

Good luck on your upcoming surgery.

Congratulations on the success of your revision and resolution of your GERD.  I am in the process of having the same revision done, sleeve to RNY for the same reason.  Very scared to have my intestines rearranged, possible dumping syndrome, and losing more weight.  I lost all my weight with the sleeve and have maintained it for over 3 years.  I'm on the low side for my BMI already.  Did you find the ways you have to eat for an RNY to be a big adjustment?  Now that more time has passed are you still free of the GERD?  Thanks for any insight you can provide.

Congratulations on getting to goal and staying there.   I was totally with you and couldn't stand the thought of having my intestines rearranged, something I thought I would NEVER do.  I'm seven months out.  My bile reflux is completely gone.   I still am having some acid reflux but its at least 50% better.  I'm back on Nexium twice a day. When I asked the surgeon at my six month follow-up he didn't think I would still have but said considering how bad it was that he wasn't totally surprised.  Guess there is a chance that it might go away completely or at least get back to one Nexium a day.

I know that doing this surgery was the right thing for my health.  I've lost 66 lbs (still have 20 more to go), my cholesterol is back down to normal, and my A1C was creeping up is back low again. Weight loss slower with revision.  I think no matter way, you're going to lose more weight especially in the beginning.

As for eating, it hasn't been all that much different.  I have some minor dumping but only if I eat something really sweet, i.e. part of a cupcake with frosting.  I don't get all the symptoms but I start feeling nausea but don't get sick.   I may end up with some diarrhea several hours later but that doesn't happen too much.  Needless to say, I've tried a few things and realized they have to completely leave my diet.  Maybe a very small bite but I truly am getting to the point I don't want it anymore.  I found that I don't feel restriction as much with RNY, felt it much more with the sleeve but I'm adjusting.  I do miss the fact that I can't take any NSAID or steroids.  Dealing with a tendonitis in my ankle and hip and frustrating all I can take is tylenol or have pain meds.  I can get a cortisone shot but have to be careful and make sure I take the PPI.  My surgeon said he has some people on NSAIDs but wants to avoid it if at all possible.

I didn't have to change any of my medications. I still take over the counter vitamins and my six month blood work shows all is well.  It was actually a little easier recovery since I already new what to expect and my stomach was already used to a smaller volume.

The only other issue I've seen since the RNY is that my intestines have become very noisy, not all the time so can't decide what starts it off.

For the big question, if I turned back time to before the revision would I do it again, I can't really give an answer on that one just yet.  I've definitely had some regrets but some of that is my personal hangups.

Hopefully this helps somewhat in you making your decision.

Thank you so much for your comprehensive reply.  I was wondering how you know the difference between bile reflux and acid reflux?  I also have a narrowing about midway down my sleeve which the surgeons also feel contributes to my food often getting stuck in my esophagus, along with some motility issues.  Did you get that stuck feeling?  I sometimes have to vomit for relief.  It's such a complex situation.

I had a 24 hour ph monitoring test.  Tube down through the nose for 24 hours attached to a monitor.  With this test they can tell which is acid and which is bile.  Also, the bile, when it comes up the throat is very foul tasting and can be a little green.  I think the GERD was controlled by the PPI but doesn't have an effect on the bile.  They had me try some nasty liquid med which was supposed to help but it was so hard to drink. I'd wake up in the middle of the night choking on the bile.

I still have some swallow issues on occasion and yes I have to vomit sometimes since it will get caught in throat.  They did another test which showed I had a "hypertensive" esophageal  sphincter.  Of course doesn't make sense that I was having GERD with it but everything with me seems to be different.   Before the RNY I had a gastric emptying test which didn't show any issues with motility.

Any way they can fix the narrowing in the sleeve without doing RNY?  I feel your pain and hopefully you can work through this.

They tried dilating the narrowing but it didn't work and it also takes a sharp turn.  I had a lot of the same tests you had.  I think my BRAVO test only showed I had acid reflux but I'm not sure.  However, I was on Dexilant atthe time.  Usually you have to go off it for the test but I was so bad the Dr told me to stay on it.  It was still severe.  I used to wake up choking but 300mg of Zantac at bedtime stopped that.  I also take Omeprazole 40 mg 2x/day.  They feel the food getting stuck may be from the narrowing.  I've been dealing with this for 4 years and eager to get a resolution.  3 surgeons and 2 Gastroenterologists all gave the same opinion to revise to RNY. 

Actually Bravo only shows acid, doesn't register anything else.  The test I had was different, Gastro didn't want to do Bravo since it doesn't register bile and they believed that was part of the problem.  I was on Nexium 2/day for my test too.    The bile reflux is gone and the acid is 50% better and controlled with a PPI, I'd say that was a big improvement.

Sounds like you have been through everything and now you just have to make your decision.  I know I've given you a lot of information, probably more than you wanted  :-) but for the most part, I can say there hasn't been much difference in what and how I can eat.  

Did Gastro want to know if you were also refluxing bile in order to prescribe the best medication for you or was that going to make a difference in his recommendation for RNY?  I'm not sure I have that much bile.

I think that test is his preference.  He left town and I have another gastro and his preference is that test too.   I think they wanted to see why I was having reflux while I was still on a PPI.  When the surgeon first recommend revision I was no way but knowing I had bile reflux was made me consider having the bypass.  Don't think it made a difference in recommendation for RNY and don't think it makes any difference in the issues you are having.

Thanks for all the great info and for answering all my questions!  A few more question if I may...did you have to go thru a pre-op program to learn to eat for an RNY?  If so about how long was the program?  Did you have to have a psych eval?  I have to go thru a pre-op program.  Don't see why I have to have a psych eval though since I'm having the surgery for medical reasons other than weight loss.